Provider Demographics
NPI:1922554351
Name:SHIELDS, JENALEE NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENALEE
Middle Name:NICOLE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 LAKE JAMES DR
Mailing Address - Street 2:STE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6780
Mailing Address - Country:US
Mailing Address - Phone:757-523-0022
Mailing Address - Fax:
Practice Address - Street 1:704 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4544
Practice Address - Country:US
Practice Address - Phone:757-240-5580
Practice Address - Fax:757-250-5578
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-10-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical